Building an economic case for mental health promotion. Part 1

L. Friedli and M. Parsonage

Journal of Public Mental Health, vol. 6, issue 3, 2007, p. 14-23

The evidence summarised in this paper demonstrates a very strong general case for mental health promotion, broadly defined to include the prevention of mental illness and the promotion of positive mental health and well-being. The costs of mental ill health are extremely high, due to the widespread occurrence of mental illness, its typically early manifestation and persistence over the lifespan and the multidimensional nature of its consequences. The benefits of positive mental health, although more difficult to quantify, include improved physical health, reductions in health damaging behaviour, greater educational achievement, increased productivity, reduced crime, and higher levels of participation in community life. One example of a common mental health problem for which there is robust evidence of effective interventions is conduct disorder. This paper estimates that preventing conduct disorders in the most disturbed children would save around £150,000 per case (lifetime costs) and that promoting positive mental health in children with moderate symptoms would produce savings of around £75,0000 per case.

Historically social care for people with mental health problems in England has been predominantly organized through local government social services departments, while healthcare is provided through NHS Trusts. In Northern Ireland, social and health services have been jointly administered by Trusts for a number of years and this arrangement should in theory promote collaborative working. Data were gathered from a postal survey of care management arrangements in local authority social services departments in England and health and social services trusts in Northern Ireland. Results show that the structurally integrated health and social services trusts in Northern Ireland are more conducive to collaborative working, but are insufficient to secure it. This may imply that greater structural integration per se may not lead to better service outcomes.

Counting heads

C. Jackson

Mental Health Today, Oct. 2007, p. 12-13

This article summarises the findings of the first report from the Mental Welfare Commission on the use of community compulsory treatment orders in Scotland. Although use of community compulsory treatment orders in Scotland is rising steadily, the overall use of compulsory powers is falling. Hospital and community compulsory treatment orders fell overall from 1638 in January 2006 to 1485 in January 2007. Within these figures, the percentage of community-based orders rose from 4% to 18% - from 65 to 268. CCTOs have continued to rise and reached 280 by April 2007.

Decisions, decisions

T. Williamson

Mental Health Today, Oct. 2007, p. 27-29

This article sets out to explain the implications of the Mental Capacity Act for mental health practitioners. It covers the relationship between the Mental Health Act and the Mental Capacity Act, explaining that people who have been admitted to hospital under the MHA have not lost all capacity to make decisions. Moreover, a deputy or attorney appointed under the Mental Capacity Act has power to give or refuse consent to treatment on behalf of a person who lacks capacity unless the patient is being compulsorily detained under the Mental Health Act.

Growing old disgracefully

M. Lee

Mental Health Today, Oct. 2007, p. 30-32

The levels of unmet mental health needs among older people are extremely high. Over a third of older people in the UK experience symptoms of mental health problems such as depression, anxiety, delirium (acute confusion), dementia, schizophrenia, bipolar disorder and prescription drug abuse. However mental health problems in older people are under-diagnosed and under-treated in primary care and care homes. Even when older people are admitted to hospital for acute care, mental health problems are not picked up by staff on general wards. Tightening eligibility criteria mean that social care services are being concentrated on fewer people with the most acute needs, so older people with mild or moderate mental health problems and their carers miss out.

No-one wins in homicide blame game

C. Vize

Health Service Journal, vol. 117, Nov. 29th 2007, p. 18-19

Independent inquiries into homicides by mentally ill people produce little real change in systems. They appear to be motivated by public pressure for blame to be laid at the doors of individual health professionals. Concerns that most frequently crop up in inquiry reports centre on communication, record keeping and risk assessment. Addressing these issues demands concerted, shared action at the national level.

How we can find hope for the lost generation

A. McCulloch

Health Service Journal, vol. 117, Nov. 1st 2007, p. 20-21

Each year about one in five children suffers from mental health problems, but not all require access to mental health services. Most troubled youngsters could be helped by universal services or in primary care by training up frontline professionals who are involved in children's services, but are not themselves mental health specialists. Young people themselves want to access mental health services via generic one-stop-shops which offer mental health advice and support alongside help with other problems such as debt, housing or sexual health. Voluntary sector organisations have proved particularly adept at providing this type of generic service.

Listen up! Person-centred approaches to help young people experiencing mental health and emotional problems

I. Garcia, C. Vasiliou and K. Penketh

London: Mental Health Foundation, 2007

This report describes the positive practice models developed by the Caterpillar Service in Cardiff. It works with young people aged 12-21experiencing mental health problems and was set up in 2002 following a two-year consultation. The project aims to offer a safe, friendly, welcoming place for young people, and a space that promotes self-development, peer support, and opportunities to express creativity and have fun. The report calls on the government to reassess services for young people and, in particular, to consider the gap between child and adolescent mental health services and adult mental health services. It asserts that voluntary sector providers must be given the financial and political backing to offer the flexible, holistic and informal services that young people want.

Representing the vulnerable

K. Gibson and F. Hipperson

Family Law Journal, Oct. 2007, p. 14-16

Following the implementation of the Mental Capacity Act 2005, the authors discuss the correct steps for family practitioners to take when acting for a client with a mental disorder. If in doubt about a client's mental capacity, guidance should be obtained from a medical expert. Once it has been determined that a client is incapable of giving instructions in relation to their case, the family practitioner should follow the procedure for appointing a next friend or guardian.

The safety scandal

E. Dent

Health Service Journal, vol.117, Nov. 8th 2007, p. 22-24

Sexual harassment of women patients is widespread on psychiatric wards, but incidents are treated as a normal part of mental health inpatient life. Disbelief is built into the system. There is an attitude among staff that patients cannot be believed because they are ill. A lack of adequately trained and experienced staff can exacerbate poor levels of safety.

Services for young people with learning disabilities and mental health needs from South Asian communities

Children and young people with learning disabilities and mental health problems from black and minority ethnic communities face inequalities and delays in accessing services. This study mapped service access and utilisation by young people with learning disabilities and mental health problems from the Pakistani and Bangladeshi communities in Bradford. Overall the participants accessed primary health care services through their GPs, had contact with social services for support and benefits and used the voluntary sector for culturally appropriate services. Most did not access statutory mental health services, or professionals such as psychologists. Families reported barriers such as lack of awareness of services, language barriers, and lack of culturally sensitive services.

Unhappy old age

S. Shepherd

Health Service Journal, vol. 117, Nov. 1st 2007, p. 26-28

It is estimated that as many as one in four older people suffer depression, yet the vast majority get no treatment for it due to cuts in specialist inpatient and community services, and redirection of funding to services aimed at working age adults. However a national campaign by the Care Services Improvement Partnership is aiming to help nurses on general wards to support older people with dementia or depression, and some primary care trusts are pioneering innovative approaches. The spiralling number of elderly mentally ill means that more service change is urgently needed.